Editorial: Making Medicaid expansion work

It’s a safe bet that Medicaid (MaineCare) expansion in Maine will not occur on Governor LePage’s watch.

Historical overview: Voters approved expansion in November 2017 by a 59-41 percent margin. The Governor, citing fear of red ink and past performance when the MaineCare door was opened a little wider, refused to implement expansion. A component of the Affordable Care Act, the expansion would provide coverage for low-income Mainers earning up to 138 percent of the federal poverty limit.

LePage continued to condemn, resist and fight. Although the federal government would more than match Maine’s additional expenditure to extend the coverage, the foot dragging persisted through the summer. Finally, earlier this month the Governor complied with a court order and submitted to the federal government the required documents for Medicaid expansion that would provide coverage for another 70,000 Mainers. But, in a P.S., LePage asked the feds to deny Maine’s application.

Through the years, Medicaid eligibility has been expanded to reach more categories of individuals. Income levels and age requirements have been modified. And what was once a federal-only program is now a joint federal-state health insurance program with taxpayers shouldering an increasingly heavy financial load.

Governor LePage, who inherited immense funding issues from Maine’s earlier stab at expansion, demanded that the Legislature provide a funding mechanism for the new expansion. The Legislature did so earlier this summer. But LePage vetoed the $60-million funding package, saying it was not sustainable.

If the Maine plan is approved over the Governor’s resistance, two crucial issues have to be settled: funding and oversight.

The vetting of candidates for Medicaid is the job of Maine’s Department of Health and Human Services. At this writing, there are several hundred job openings at DHHS, including 27 Medicaid eligibility specialist openings (vacancies since March 2018). These are vacancies no one is applying for, let alone meeting the qualifications necessary for handling the specialized responsibilities of adequately handling the growing claims and applications for eligibility. DHHS says an additional 100 specialists would be needed to handle another 70,000 eligible applicants. Not unlike your favorite restaurant in Bar Harbor or Ellsworth, or finding a decent plumber or electrician — there are not enough willing and qualified workers to fill the existing employment demands at DHHS. This is a situation that must be addressed at once.

As to funding the expansion, Maine legislators can find the money to fill the first year or two of subsidy payments. They have shown they can do it. But can they come up with an enduring funding mechanism? Medicaid can be a lifeline, but a lifeline must be secured to a fixed and upright stanchion. Making the expansion work will require money and staffing. The Legislature has work to do.

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